Table 3.
General and Specific Contextual Effects on Schizophrenia Risk
| Basic adjustmenta,b | Full individual-level adjustmenta,c | |||
|---|---|---|---|---|
| Specific contextual effect | General contextual effect | Specific contextual effect | General contextual effect | |
| Neighborhood-level socioeconomic indicatord | Incidence Rate Ratio of neighborhood per 1 sd increase | Median Incidence Rate ratio (95% Probability Interval | Incidence Rate Ratio of neighborhood per 1 sd increase | Median Incidence Rate Ratio (95% Probability Interval) |
| None | - | 1.37 (1.31–1.43) | 1.30 (1.23–1.36) | |
| Material deprivation | ||||
| PI low Income | 0.96 (0.92–1.00) | 1.36 (1.30–1.42) | 0.93 (0.89–0.97) | 1.29 (1.22–1.35) |
| PI short education | 0.89 (0.85–0.93) | 1.35 (1.29–1.41) | 0.87 (0.84–0.91) | 1.27 (1.21–1.34) |
| PI not employed | 1.38 (1.28–1.49) | 1.33 (1.27–1.39) | 1.21 (1.13–1.30) | 1.28 (1.22–1.35) |
| PI manual workers | 1.02 (0.98–1.06) | 1.37 (1.31–1.43) | 0.97 (0.94–1.02) | 1.30 (1.23–1.36) |
| PH overcrowded | 1.16 (1.12–1.20) | 1.34 (1.27–1.40) | 1.11 (1.07–1.15) | 1.28 (1.21–1.34) |
| PH no car owned | 1.44 (1.38–1.51) | 1.24 (1.16–1.30) | 1.32 (1.26–1.38) | 1.22 (1.14–1.29) |
| Social fragmentation | ||||
| PH lone adult | 1.53 (1.44–1.63) | 1.27 (1.21–1.34) | 1.36 (1.28–1.45) | 1.24 (1.17–1.31) |
| PH rents home | 1.29 (1.25–1.34) | 1.26 (1.19–1.32) | 1.21 (1.17–1.26) | 1.23 (1.16–1.30) |
| PI residential transience | 1.21 (1.16–1.26) | 1.32 (1.26–1.38) | 1.14 (1.10–1.19) | 1.27 (1.21–1.34) |
| Social marginalization | ||||
| PI violent offending | 1.21 (1.18–1.25) | 1.29 (1.23–1.36) | 1.13 (1.10–1.17) | 1.26 (1.20–1.33) |
| PI any criminality | 1.15 (1.11–1.19) | 1.33 (1.27–1.39) | 1.08 (1.05–1.12) | 1.28 (1.22–1.35) |
| PI born abroad | 1.22 (1.18–1.26) | 1.30 (1.24–1.36) | 1.16 (1.12–1.19) | 1.26 (1.19–1.32) |
| Physical illness | ||||
| PI Physical illness | 1.16 (1.10–1.22) | 1.35 (1.29–1.41) | 1.12 (1.07–1.18) | 1.28 (1.22–1.35) |
| All area-level indicese | – | 1.23 (1.16–1.30) | – | 1.22 (1.14–1.29) |
The specific contextual effects are the neighborhood-level indicators examined. The general contextual effect estimates effects of neighborhood context on disease incidence without reference to any of the specific neighborhood-level constructs other than the very boundaries defining neighborhoods.
PI: Proportion of individuals; PH: Proportion of households
a Estimates were based on multilevel survival analyses, neighborhoods are 1885 novel data zones nested in Denmark’s 98 municipalities. The 579 039 people born in Denmark 1972–1981 were followed for development of schizophrenia. During the follow-up period from 1982 to 2016, a total of 5103 developed schizophrenia during the 17 191 889 person-years at risk
b Estimates were adjusted for individual-level age and its interaction with sex and neighborhood-level age distribution (Basic adjustment).
c Estimates were adjusted for Basic adjustment and individual-level residential instability, parental Charlson, parental death, parental imprisonment, parental age, parental history of mental disorders, parental income, parental employment status, and parental education.
d Neighborhood-level covariates measure the effect of a one standard deviation increase in the proportion of each covariate. Neighborhood-level covariates were data zone-level averages 1981–1984 (details in Supplementary Methods 2). The effects of each neighborhood-level covariate were modeled separately.
e Neighborhood-level covariates were summarized using the first 3 Principal Components of all neighborhood-level covariates (excl. urbanicity and population density). The fixed effect (specific contextual effect) estimate is not comparable to the other neighborhood-level fixed effects and is therefore not shown.